Triptans. Your doctor may prescribe triptans, medications that block pain signals in your brain. Triptans often relieve pain from your headache within two hours and help control vomiting.

NSAIDs with triptans. Some women may take a combination of NSAIDs and triptans to relieve pain from menstrual migraines.

Other prescription pain medications. Sometimes your doctor may suggest other prescription pain medications, such as dihydroergotamine (D.H.E. 45). These cannot be taken in combination with triptans.

Preventive treatment

If you have several debilitating headaches a month, your doctor may recommend preventive treatment with NSAIDs or triptans.

If your menstrual cycle is regular, it may be most effective to take preventive headache medication starting a few days before your period and continuing through up to two weeks after the start of your period.

If you have migraines throughout your menstrual cycle or you have irregular periods, your doctor may recommend that you take preventive medications every day.

Daily medications may include beta blockers, anticonvulsants, calcium channel blockers, antidepressants or magnesium. Your doctor might also consider monthly injections of a calcitonin gene-related peptide (CGRP) monoclonal antibody to help prevent your headaches, especially if other medications aren't effective. Doctors will likely review any other medical conditions you may have to determine which medications may be most appropriate for you.

Making lifestyle changes, such as reducing stress, not skipping meals and exercising regularly, also may help reduce the frequency, length and severity of migraines.

Hormonal contraception use

Hormonal contraception methods, such as birth control pills, patches or vaginal rings, may change existing headache patterns — headaches may improve or worsen, or sometimes stay the same.

For some, hormonal contraception may help reduce the frequency and severity of menstrual-related migraines by minimizing the drop in estrogen associated with the menstrual cycle.

Using hormonal contraception to prevent menstrual-related migraines may be appropriate for women who haven't been helped by other methods.

Other women may first experience migraines while using hormonal contraception. If you experience migraines while using hormonal contraception, talk to your doctor.

Tips for using hormonal contraception:

Use a monthly birth control pill pack with fewer inactive (placebo) days.

Eliminate the placebo days completely from most months by taking extended-cycle estrogen-progestin birth control pills (Camrese, Seasonique, others).

Use birth control pills that have a lower dose of estrogen to reduce the drop in estrogen during the placebo days.

Take NSAIDs and triptans during the placebo days.

Take a low dose of estrogen pills or wear an estrogen patch during the placebo days.

Use an estrogen-containing skin patch during the placebo days if you're using a birth control patch.

Take the minipill if you're not able to take estrogen-progestin birth control pills. The minipill is a progestin-only birth control pill (Camila, Ortho Micronor, others) that's an alternative to oral estrogen-progestin birth control pills if you're not able to take estrogen-progestin birth control pills due to other conditions.

During pregnancy

Estrogen levels rise rapidly in early pregnancy and remain high throughout pregnancy. Migraines often improve or even disappear during pregnancy. However, tension headaches usually won't improve, as they aren't affected by hormone changes.

If you experience chronic headaches, ask your doctor about medications and therapies that can help you during pregnancy before you become pregnant. Many headache medications may have harmful or unknown effects on a developing baby. You and your doctor might want to have a thorough discussion about whether you should use medications during pregnancy.

After delivery, an abrupt decrease in estrogen levels — along with stress, irregular eating habits and lack of sleep — may trigger headaches again.

Although you'll need to be cautious about which headache medications you take while you're breast-feeding, you'll likely have more options than you did during pregnancy. Your doctor can tell you which medications you may take while you're breast-feeding.

During perimenopause and menopause

For many women who have had hormone-related headaches, migraines may become more frequent and severe during perimenopause — the years leading up to menopause — because hormone levels rise and fall unevenly.

For some women, migraines improve once their menstrual periods stop, but tension headaches often get worse. If your headaches persist after menopause, you likely can continue to take your medications and use other therapies.

Hormone replacement therapy, which is sometimes used to treat perimenopause and menopause, may worsen headaches in some women, improve headaches in others or cause no changes. If you're taking hormone replacement therapy, your doctor may recommend an estrogen skin patch. The patch provides a low, steady supply of estrogen, which is least likely to aggravate headaches.

If hormone replacement therapy worsens your headaches, your doctor may lower the estrogen dose, change to a different form of estrogen or stop the hormone replacement therapy.

You are unique

Some women are more sensitive to the effects of hormones. If headaches are disrupting your daily activities, work or personal life, ask your doctor for help.

Reprint Permissions

A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.